915816 tn?1243226696
Totally Blocked RCA - Too many stents
I am writing on behalf of my husband.  He is 43 yrs old and had his first heart attack in 1999.  At that time they placed two stents in theright man artery.  They were approx. 99% blocked.

He did fairly well until 2004  when he had been experiencing pressure, heaviness, what he thought may have been heartburn.  At that time the dr. placed 5 stents his RAC.. same artery as in 1999.  He has had numerous caths and  at this time a total of 10 stents in the RAC. Two of those being a stent within a stent.  The last stent placed within a stent before this was in December of 2008.

He is overweight and has numerous other health problems.

1. Lupus
2. Diabetic Neuropathology
3. Arthritics
4. High blood pressure
5. HDL not high enough, LDL not low enough.  Triglycerides are high
   (but down tremendously from the start of all of this)  Overall
   cholesterol is better than mine.  Much better.
6. He has had his gallbladder out
7. He has had low back surgery
8. He has sleep apnea

He is a good man, loving and has all his years had a tremendous sense of humor and now I see pain and worry on his face.  Bless his heart just having a hard time of it due to health issues.  He never has a pain free day when it comes to chest pains.  If you need to speak to him personally his number is on the
bottom of this email.

Apparently he is not a candidate for by-pass  with his current cardiologist.  (A very agressive Dr. and one we really like) My husband is high risk and the problems seems to be that there may not be enough space to attach an artery from the aortic artery to the bottom of  the vessel. The dr. said he is not sure there enough space on one end or the other of the artery to attach a by-pass.  I just need some info and am in total desperation as to what we should do now.

He was cathed on Wednesday, July 1st, and there was another stent placed in the same RAC with 90% blockage inside of a stent.  The Dr. told us that he could, "stent until the cows come home." My husband did not do as well in my opinion as with prior stenting.  They had a bit of problems at the cath entrance site with bleeding.  I cannot see him doing this too many more times.  He  is physically unable to endure more of these and also I think it plays on his mind.. It certainly does mine. I am wanting a plan because as many times as he has done this, I know it will happen again and I want to be prepared so he may be considered as a possible by-pass candidate.   I look forward to your answer.

I have acquired the CD of several of the caths and can make a copy.  I would need to know how to label it.  What info would you need?  I have the hospital records from the last few visits.  There are alot of them so are there any particular pages I would need to send with the CD?
I look forward to know if you thought that it might be worth getting a second opinion for my husband.

I have found a surgeon in Houston who says he can do the surgery.  A Bypass.  But that is so far.  Surely there is a surgeon in the Dallas area who can see my husband.

Since this letter was written,,,My husband has been in the hospital two times.  They did not do anything the first time.  Just sent him home because while in the hospital he had no episodes..
Then, last week he was getting dressed to go to a Dr. appt. and he had to sit down.  He said he thought he was having a heart attack.. His enzymes were indeed elevated and so a cath was done with no intervention.  A surgeon said there was no room to attach for a by-pass,  They said he could live with the RCA totally blocked.. I just cannot believe that.. Any suggestions?
2 Answers
Page 1 of 1
976897 tn?1379171202
Firstly I would just like to say that when something is affecting the heart, it is very scarey and it does make you immediately keep thinking of death. It is important to keep
in mind that knowledge, technology has come forward leaps and bounds in the last 10
years. I guess what I'm trying to say is, keep a level head as your are doing and make
sure you continue to look into what Doctors recommend.
It sounds as though the RCA is severely diseased and is continuing to disease at quite
a high rate. To keep requiring stents suggests the disease is not slowing down. Is he
on cholesterol lowering medication and is his blood pressure normal? It can be a never ending battle fighting a disease if you don't get it under control. To stop my disease increasing I had to get my cholesterol very low and change my outlook on life. Instead of taking life seriously and worrying about everything, I had to boost my sense of humour.
The left side of the Heart does most of the work, it has the task of pushing fresh blood to all parts of the body and back to the right side of the heart. The right side of the Heart
basically only has to push blood through the lungs and back to the left side of the heart.
You don't mention anything about the Left anterior descending or the Circumflex so I
assume these vessels are working adequately which is a good thing. Your Doctor is
correct when he states the RCA can be totally blocked but it depends where the blockage is. The left side is the most important.
If I was in your shoes, I would look into the option of a bypass. You can have stent after
stent but each one adds to the risks. With a bypass you can ask about the possibility of
a full endarterectomy. Arteries have three main layers and an arterectomy involves removing part of the inner layer, normally around the graft site in a bypass. However, the
surgeon may be able to perform a full endarterectomy on the vessel. An incision would be made at one end of the vessel and the inner lining pulled out completely, along with
the disease. Sure, there are risks, but there are always risks to anything and your Doctors will be able to talk about this procedure (if they have the expertise).
Once this procedure is performed, there will be a nice artery to graft onto, or it may not
require grafting at all. Whatever procedure you opt for, you seriously need to slow down
the disease by getting his cholesterol levels rock bottom and having beta blockers.
Has a transplant been offered? if so, my advice is ignore this until absolutely ALL other
possible avenues have been explored.

As a final piece of advice, do you know of any research centres that you can get hold of?
I had three main Heart hospitals tell me there is nothing they can do and a transplant is
my only option. I approached Imperial College Research London and they have said they
can treat me with a 1% risk. Research hospitals have a much different outlook and see
things as a challenge rather than a burden. Please tell your husband not to be depressed
because I was told for 2 years that I should have a transplant. You should never give up
because there is a doctor out there who can do something, it's just a matter of time before you find him.
Please keep us informed.

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I feel very sad for your husband and I am in somewhat of the same predicament as he is in. I would highly advise a dean ornish style diet. It has worked for many people with regards to avoiding bypass/transplant scenarios. You can google his name or that of Dr Fuhrman. Both heart diet plans have shown to reverse heart disease and to relax artery's and lower blood pressure and normalize HDL/LDL. I started the diet in February and have lost 30 pounds and my HDL is 45 and my LDL is 65. My Trigs went from 186 to 70. I am just trying to help , look into both of those doctors and go to their websites and it may help him avoid heart attacks and slow or stop the progression of those blockages. Either way I wish him better health and you are a doll for worrying about him in this fashion.
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